[Supplement Course 4/5] What to look out for when buying supplements, Part 2

In the last email, we went over practical considerations for buying supplements, including quality and dosages. But none of that matters if you choose the wrong supplementation strategy. While giving lectures on this topic, I’ve noticed two common categories of audience members: - One group takes one or two supplements a day (or even zero) - The other takes a lot of supplements every day (think 10-20) Is one of them right and one wrong? Or can they both be right? Where do supplement fit in an overall health strategy? After many years of reviewing supplement research, and publishing peer-reviewed articles on supplements, I can safely tell you: Supplements aren’t among the most important parts of a typical health strategy. Some of the most important parts all happen to start with the letter “S”, funny enough, so they’re easy to remember: sleep, stress management, and socializing. 1. Sleep: more powerful than any pill Without consistent and adequate sleep, your gains at the gym will be stymied, inflammation becomes more likely, and in general, you become more susceptible to disease. If you’ve had sleep issues in your life, you already know the detriments of getting poor sleep. 2. Stress: manage it, or it will manage you Stress management is best explained by understanding the role of the fight or flight system. Our nervous systems and endocrine systems have evolved to shoot out extra hormones and neurotransmitters during infrequent stressful situations (e.g. being chased by a lion), but aren’t optimized for frequent seemingly stressful situations (e.g. being stuck in traffic, hearing an annoying coworker, or simply having repetitive negative thoughts in your head). To maintain a healthy body in the long term, you absolutely have to figure out how to manage stress, using mindfulness or therapy or whatever suits you best. A stressed body will overreact with inflammation, and not be resilient enough enough to handle disease well. 3. Socializing: underrated for health improvement Socializing seems like a strange one to include, but humans are social creatures (unlike several other mammals, actually). Modern life, stuck staring at a computer or phone screen most of the day, often doesn’t fulfill our socializing needs. This may be tied to depression and other mood issues, as well as disrupted circadian rhythms. These three factors, along with emphasizing a diet low in ultra-processed food and getting enough movement each day, should take up a big chunk of your self improvement efforts. If you’re spending a lot of time and money on supplements, that may be distracting from these big issues that have outsized impacts on health. So where might supplements fit in an overall health strategy? As a carefully-selected support team, not as a first option. The cycle of stress and lost sleep can be hard to break and can interfere with your social life and exercise, which can then increase stress and interfere with sleep. That vicious cycle is all too common among our readers. While there are no supplements that will single-handedly reverse the cycle, a carefully-selected supplement could modestly improve one of these important factors and get you back on the path to wellness. Where do supplements fit in a dietary strategy? Food is generally superior to supplements for health promotion, but it can get complicated. For example, fiber. Food contains fiber, so there’s typically no need to supplement with fiber. But supplementing fiber can be useful for certain situations. For example, if you’re sensitive to a variety of fiber-containing foods (e.g. foods containing [FODMAPs](=)), supplements can help top up your fiber intake. Certain types of fiber have also been tested in randomized trials for indications ranging from gut health to diabetes, so taking a supplement may be a way to get a reliable clinical effect. Different diets and disease states could also necessitate supplementation, with vitamin B12 for vegans being the most common example. Seniors can also benefit from certain supplements, due to physiological changes that occur with aging. But you can’t live on supplements alone. While you might think that’s obvious, there are specific examples of supplements falling short. For example, supplementing won’t work for meeting your daily potassium requirements, because the maximum legal amount in supplements (less than 100 mg, due to chances of serious side effects from overdosing) is far lower than the adequate intake of 2,600 mg for women and 3,400 mg for men. The bottom line here is to build a strong foundation through foods, and only then supplement for specific reasons. These reasons can range from targeting difficult-to-treat health conditions to maximizing athletic performance. Remember that a supplement is “something that completes or enhances something else when added to it”. Supplements work best when enhancing a strong foundation. When trying to enhance a weak foundation with supplements, don’t be surprised if the foundation crumbles, and no supplement seems to help. You simply can’t outrun a bad diet, poor sleep, and inadequate stress management. Who can I trust when it comes to supplement information? No one, other than Examine.com. Kidding! (kind of) Supplements are simply not held to a high standard. One reason is that in 1994, the United States Congress passed the [Dietary Supplement Health and Education Act](, which solidified that FDA approval isn’t required to market supplements, and companies don’t have to prove they work or that they’re even somewhat safe (shocking!). They simply have to refrain from making any explicit medical claims — a thin line that many companies get close to or even eclipse. This has lead to an enormous amount of nonsense about supplements, based on very little research. Companies can’t claim that a supplement treats depression, but they can strongly suggest that it improves mood, even if the research doesn’t support any such thing save for a study on diabetic rats. The media and celebrities are rarely any better, and [this is largely how people form beliefs about supplements](). Some less-than-reputable media outlets will make a big deal about a single study, treating it as “breaking news” in an attempt to draw in more clicks and hence more advertising dollars. The problem with this is that a single study isn’t reliable. Science is a slow process. It involves a gradual progression of research through multiple studies, testing and re-testing hypotheses. Testing and re-testing are both important! For example, large supplemental doses of vitamin A were suggested to improve health in older research, then later found to be potentially dangerous in more rigorous trials. That’s why Examine.com scrutinizes all of the research, so we don’t jump to the wrong conclusions. Our researchers are trained to start their analysis without any assumptions, and draw in the details solely using evidence, rather than opinion. Why does nutrition and supplement research seem to flip flop so often? This is a super important question, and the answer is complicated. When I’d ask questions like this to my fifth grade English teacher, Mr. Benson, he’d answer “My dear Kamal … Ours is not to reason why, ours is but to do or die!”. (There was no Internet back then, so it took me a couple decades to figure out the quote was by Alfred, Lord Tennyson. Not Mr. Benson.) But then he’d answer the question at length, covering every nuance. What an amazing teacher, that Mr. Benson. So let’s reason this out, instead of giving a simple answer, so that you can dig into the bigger picture issue of supplement science. - There’s always new research, and supplements that may have been supported by early small studies can lose favor as larger studies with rigorous methodology are published. We strive to take this into account in our analyses at Examine.com, but keep in mind that this makes us less fallible, not infallible. We’re constantly updating our pages with new studies and working to improve our analyses. - Taking almost any supplement is a bit like gambling: You pay for the possibility of returns, but you can’t win them all. Taking only supplements that are backed by a sufficient amount of good research is your best bet, but even the definition of good research changes from decade to decade. Case in point: Going back 2-3 decades, meta-analyses were rare-to-nonexistent in nutrition and supplementation, and now they’re possibly overabundant! - Along those lines, the average study conducted in the year 2000 was lower quality than one done in 2019. Researchers have become more transparent and use more rigorous methods to minimize bias. Trials are more often pre-registered, to avoid shenanigans while writing up results. Research teams more often employ a biostatistician, making analyses more standardized and reliable. And we have much expanded knowledge of physiological mechanisms: better clues into how supplements might work in the body has lead to better ways to conduct studies. - Science isn’t static. It progresses in ebbs and flows, and while old errors are corrected and methods improve, the public discourse takes a while to catch up. But science also isn’t monolithic: just like researchers disagree in any other academic field (string theory vs particles, physics nerds?), so do nutrition and supplement researchers disagree. All of this points to a major takeaway: It’s important not only to take supplements with the best evidence supporting them, but also to check back every now and then to see if anything has changed. Phew, that was quite a lot of information to cover! But if you’re thirsty for more while waiting for the next email, we have some tips for navigating the turbulent ocean of health media in this article: [Not all clickbait is obvious](). And lastly, here’s your homework: Read our article on some [popular nutrition myths that just won’t die](=), and then let us know [which ones you already knew and which were surprising](). Kamal Patel Co-founder, Examine.com [Unsubscribe]( | [Update your profile]( | PO Box 592, Toronto, Ontario M5S 2T1